| National Provider Identifier [NPI]: | 1679573331 |
| Last Name Of The Provider | STAWISKI |
| First Name Of The Provider | MAREK |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 833 MICHIGAN ST NE |
| Street Address 2 Of The Provider | SUITE 102 |
| City Of The Provider | GRAND RAPIDS |
| Zip Code Of The Provider | 495033523 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 81 |
| Number Of Services | 8745 |
| Number Of Medicare Beneficiaries | 1785 |
| Total Submitted Charge Amount | 842309.13 |
| Total Medicare Allowed Amount | 480682.76 |
| Total Medicare Payment Amount | 342428.31 |
| Total Medicare Standardized Payment Amount | 361549.4 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 77 |
| Number Of Medicare Beneficiaries With Drug Services | 30 |
| Total Drug Submitted ChargeAmount | 4907.13 |
| Total Drug Medicare AllowedAmount | 4647.16 |
| Total Drug Medicare PaymentAmount | 3592.27 |
| Total Drug Medicare Standardized Payment Amount | 3592.27 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 78 |
| Number Of Medical Services | 8668 |
| Number Of Medicare Beneficiaries With Medical Services | 1785 |
| Total Medical Submitted Charge Amount | 837402 |
| Total Medical Medicare Allowed Amount | 476035.6 |
| Total Medical Medicare Payment Amount | 338836.04 |
| Total Medical Medicare Standardized Payment Amount | 357957.13 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 253 |
| Number Of Beneficiaries Age 65 to 74 | 661 |
| Number Of Beneficiaries Age 75 to 84 | 529 |
| Number Of Beneficiaries Age Greater 84 | 342 |
| Number Of Female Beneficiaries | 853 |
| Number Of Male Beneficiaries | 932 |
| Number Of Non Hispanic White Beneficiaries | 1621 |
| Number Of Black or African American Beneficiaries | 86 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 38 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 26 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1468 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 317 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.1254 |